Assessment of infection rate during the induction phase in acute leukemia patients

Tạp chí Y học lâm sàng Bệnh viện Trung Ương Huế - Tập 17 Số 5 - Trang - 2025
Nguyen Thi Kim Hoa, Phan Hung Viet, Truong Thi Minh Tam

Tóm tắt

Introduction: Acute leukemia is the most common cancer in children, and infections is one of the major complications during treatment. This study aimed to assess the incidence of infections during the induction phase of acute leukemia treatment. Methods: Patients diagnosed and treated for acute leukemia between December 2022 and July 2024 at the Pediatric Center, Hue Central Hospital, were included in this study. Data were extracted from medical records and analyzed using SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results: A total of 55 patients with acute leukemia were included in the study, comprising 13 cases of acute myeloid leukemia (AML), 29 cases of high-risk acute lymphoblastic leukemia (HR-ALL), and 13 cases of standard-risk acute lymphoblastic leukemia (SR-ALL). Infections occurred in 85.5% of patients during the induction phase, with the highest incidence observed in the first three weeks of treatment (95.7%). Patients with AML had a significantly higher infection rate compared to those with ALL (92.3% vs. 83.3%, p < 0.01). The most common site of infection was the oropharynx (29.8%), followed by the gastrointestinal tract (27.7%), lower respiratory tract (23.4%), and bloodstream (sepsis) (21.3%). Urinary tract infections were the least common (2.1%). Additionally, 21.3% of patients experienced infections involving two or more organ systems. The rate of positive blood cultures was 17.0%, while positive fungal cultures accounted for 4.2%. The success rate of infection treatment was 89.4%, with a mortality rate of 10.6%. Conclusions: Infections are highly prevalent during the induction phase of acute leukemia treatment. Early detection and prompt administration of antibiotics are critical to managing infections and improving patient outcomes.  

Từ khóa


Tài liệu tham khảo

Malczewska M, Kosmider K, Bednarz K, Ostapinska K, Lejman M, Zawitkowska J. Recent Advances in Treatment Options for Childhood Acute Lymphoblastic Leukemia. Cancers (Basel). 2022; 14(8). https://doi.org/10.3390/cancers14082021

Zajac-Spychala O, Skalska-Sadowska J, Wachowiak J, Szmydki-Baran A, Hutnik L, Matysiak M, et al. Infections in children with acute myeloid leukemia: increased mortality in relapsed/refractory patients. Leuk Lymphoma. 2019; 60(12): 3028-3035. https://doi.org/10.1080/10428194.2019.1616185

Inaba H, Mullighan CG. Pediatric acute lymphoblastic leukemia. Haematologica. 2020; 105(11): 2524-2539. https://doi.org/10.3324/haematol.2020.247031

Pui CH. Precision medicine in acute lymphoblastic leukemia. Front Med. 2020; 14(6): 689-700. https://doi.org/10.1007/s11684-020-0759-8

Inaba H, Pui CH. Advances in the Diagnosis and Treatment of Pediatric Acute Lymphoblastic Leukemia. J Clin Med. 2021; 10(9). https://doi.org/10.3390/jcm10091926

Lehrnbecher T, Robinson P, Fisher B, Alexander S, Ammann RA, Beauchemin M, et al. Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update. J Clin Oncol. 2017; 35(18): 2082-2094. https://doi.org/10.1200/JCO.2016.71.7017

Logan C, Koura D, Taplitz R. Updates in infection risk and management in acute leukemia. Hematology Am Soc Hematol Educ Program. 2020; 2020(1): 135-139. https://doi.org/10.1182/hematology.2020000098

Cennamo F, Masetti R, Largo P, Argentiero A, Pession A, Esposito S. Update on Febrile Neutropenia in Pediatric Oncological Patients Undergoing Chemotherapy. Children (Basel). 2021; 8(12). https://doi.org/10.3390/children8121086

Brown P, Inaba H, Annesley C, Beck J, Colace S, Dallas M, et al. Pediatric Acute Lymphoblastic Leukemia, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020; 18(1): 81-112. https://doi.org/10.6004/jnccn.2020.0001

Hastings C, Torkildson J, Agrawal A, Acute Leukemias. Handbook of Pediatric Hematology and Oncology. 2021, Children's Hospital & Research Center Oakland, John Wiley & Son Ltd. 120-160.

Bộ Y Tế. Hướng dẫn chẩn đoán và điều trị một số bệnh lý huyết học 2022.

Hutchinson RJ, Gaynon PS, Sather H, Bertolone SJ, Cooper HA, Tannous R, et al. Intensification of therapy for children with lower-risk acute lymphoblastic leukemia: long-term follow-up of patients treated on Children's Cancer Group Trial 1881. J Clin Oncol. 2003; 21(9): 1790-7. https://doi.org/10.1200/JCO.2003.03.009

Nachman J, Sather HN, Cherlow JM, Sensel MG, Gaynon PS, Lukens JN, et al. Response of children with high-risk acute lymphoblastic leukemia treated with and without cranial irradiation: a report from the Children's Cancer Group. J Clin Oncol. 1998; 16(3): 920-30. https://doi.org/10.1200/JCO.1998.16.3.920

Tran Thi Thuy. Nghiên cứu đặc điểm nhiễm trùng ở bệnh nhi lơxêmi cấp sau điều trị tấn công tại Viện Huyết Học- Truyền máu Trung ương, giai đoạn 2019-2024. Luận Văn Thạc Sĩ Y Khoa, Trường Đại Học Y Hà Nội. 2014.

Zhu Y, Yang R, Cai J, Yu J, Tang Y, Chen Y, et al. Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG-ALL-2015. Cancer Med. 2020; 9(6): 2113-2121. https://doi.org/10.1002/cam4.2889

Rajeswari B, Sukumaran R, Guruprasad C. Infections during induction chemotherapy in children with acute lymphoblastic leukemia- Profile and Outcomes: Experience from a Cancer Center in South India. Indian Journal of Medical and Paediatric Oncology. 2018; 39: 188.

Sayed HA, El-Mahallawy HA, Kaddah AM, Ismael HT, Talaat SM. Profile of infections in newly diagnosed patients with acute leukemia during the induction phase of treatment. J Egypt Natl Canc Inst. 2009; 21(4): 315-22.

McCormick M, Richardson T, Rapkin L, Kalpatthi R. Risk Factors for Readmission Following Febrile Neutropenia in Pediatric Oncology Patients. J Pediatr Hematol Oncol. 2023; 45(4): e496-e501. https://doi.org/10.1097/MPH.0000000000002585

Carlesse F, Sousa AV. Infections in children and adolescents with acute leukemia. EJC Paediatric Oncology. 2024; 3: 100142.

Meir HM, Balawi IA. Fever and granulocytopenia in children with acute lymphoblastic leukemia under induction therapy. Saudi Med J. 2001; 22 (5): 423-427.

Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood acute lymphoblastic leukemia: an analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol. 2008; 25(5): 385-92. https://doi.org/10.1080/08880010802106564

Thông tin
Thông tin xuất bản

Tạp chí Y học lâm sàng Bệnh viện Trung Ương Huế

Tập 17 Số 5

Thông tin tác giả